Healthcare Provider Details

I. General information

NPI: 1306639844
Provider Name (Legal Business Name): EMILY BUETNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4953 HUCKLEBERRY ST NW
CANTON OH
44720-7020
US

IV. Provider business mailing address

289 TANGLEWOOD DR SW
NORTH CANTON OH
44720-3513
US

V. Phone/Fax

Practice location:
  • Phone: 330-818-0010
  • Fax:
Mailing address:
  • Phone: 330-704-6731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03442543
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: